Hurricane Ian Situation Report #15
This report provides an assessment of the impacts to healthcare and public health due to Hurricane Ian. Pending any major updates, our last situation report for Hurricane Ian response will be 10/20.
Note: Green text indicates new or updated content in this report compared to the previous report.
Healthcare Ready's Posture
Healthcare Ready is ENGAGED for the response to Hurricane Ian. We are tracking potential impacts to healthcare infrastructure and supply chain, sharing information via situation reports, Twitter, Facebook, and LinkedIn. Our pharmacy operating status map Rx Open will be updated every other day for pharmacies and dialysis centers in Florida, Georgia, South Carolina, North Carolina, and Puerto Rico. Rx Open updates will be paused following the 10/19 update.
High-Level Situation Summary
About 14,000 customers remain without power in Florida, with most outages concentrated in Pine and Sanibel Islands in Lee County. As previously reported, healthcare operations in the state have largely been restored, though many smaller or satellite facilities (including clinics and urgent care centers) still report some damages and modified operations.
Disparate delays in restoring critical infrastructure (power, water, internet) in different areas signal a need to consider equity as part of future disaster response and recovery plans. Despite continued challenges, resources (disaster recovery centers, PODS, fuel trucks, Wi-Fi hotspots) are increasing daily and are being made available in areas where support is most needed. These resources have been brought in in many ways, including through innovative sources (via businesses and partnerships). Hurricane Ian, one of the most disastrous events to hit the state of Florida, may very well be an exemplary model for a partner-centered approach to recovery from disasters. As seen throughout this recovery process, public-private sector partnerships in disaster response are a strong tool towards disseminating critical resources, achieving sustainable healthcare infrastructure restoration, and community recovery.
Highlights
- In Florida, there are 9 pharmacy closures reported on rxopen.org as of 2:00pm EST on 10/18.
- As of 10/18, over 14,000 residents remain without power, with over 11,000 outages remaining in Lee County.
- As of 10/17, parts of 10 counties still remain under boil water advisories.
- Lee County Electric Cooperative has estimated that essential electric infrastructure may be restored as early as October 20.
- As of 10/18 access to Fort Myers Beach from the south will be limited to essential response personnel to speed restoration of essential services and infrastructure. Starting Wednesday, 10/19, residents and their hired contractors can access the island from the south from 9 am to 5 pm.
- Temporarily restored Sanibel Causeway is now allowing convoys to reach the island in order to restore power. Full restoration of the causeway is expected to be finished by 10/21.
- Free telehealth services continue to be available for patients in impacted areas. See the “Healthcare Response Updates and Needs” section for more details.
- For the latest local updates, including detailed information on fuel, water, and other resource sites, visit the governor’s website and floridadisaster.biz/currentdisasterupdates for more information.
- UPS, FedEx, and USPS are still experiencing service impacts, for communities on Pine and Sanibel Island which were cut off to road access.
- Federal, state, and local agencies are urging citizens to be aware of the possibility of fraud, scams, and cybersecurity threats following Hurricane Ian.
Assessment of Healthcare and Logistics Impacts
Emergency Declarations and Measures
- General
- No changes or updates since 10/11.
Critical Infrastructure Impacts
- Power
- As of 9:00am EDT 10/18, over 14,000 residents are still without power, with over 11,000 outages remaining in Lee County.
- As of 10/15, initial assessments of the damage to the electric infrastructure in Sanibel and Captiva Islands has been deemed severe and will take months to restore. However, the Lee County Electric Cooperative has estimated that essential electric infrastructure may be restored as early as October 20.
- Long-term outages may be reported across the state for customers who will not be able to receive power due to damage or flooding. In these cases, electrical systems will need to be inspected by licensed electricians to determine if repairs are needed before power can be restored.
- Fuel
- Those looking for fuel and gas are encouraged to use Gas Buddy, to search for open stations and providers using crowdsourced information.
- As of 10/17, there are eight (8) fuel points of distribution (PODs) open in Southwest and Central Florida for first responders.
- As of 10/17, one fuel depot is open for public fueling at the Wa-Ke Hatchee Recreation Center.
- As of 10/4, all ports and terminals are open for fuel and many gas stations have begun receiving shipments.
- Water
- As of 10/17, parts of 10 counties are still under boil water advisories. Residents are encouraged to reach out to local utility or county emergency contacts for the most up-to-date information. Most advisories are issued in Hillsborough County.
- As of 10/13, all water PODs have been closed.
- FL DEP is operating one (1) mobile testing labs from the Environmental Protection Agency (EPA) to aid with processing drinking water and surface water samples.
- FDEM continues to work with the US Army Corps of Engineers to conduct infrastructure assessments of water and wastewater treatment plants.
- Florida Department of Environmental Protection (DEP) are also assessing water and wastewater infrastructure across impacted areas including Fort Meyers Beach, Pine Island, Sanibel Island, and Gasparilla Island.
- FL DEP and FlaWARN are coordinating to distribute generators, fuel, and pump trucks to support water and wastewater facilities in returning operations as soon as possible.
- Communications
- Florida
- The Federal Communications Commission (FCC) is no longer releasing new communications reports for Hurricane Ian as of 10/10. Past FCC reports can be found on their Hurricane Ian Reporting Page.
- As of 10/10, 911 calls are being answered in all areas. Calls to Sanibel Police Department Headquarters are being rerouted to another Public Safety Answering Point (PSAP).
- The (FCC) may grant Special Temporary Authority (STA) to permit immediate or temporary operation of certain radio facilities during emergencies or other urgent conditions, https://docs.fcc.gov/public/attachments/DOC-387932A1.pdf as well as waivers to support emergency communications and service restoration.
- Verizon’s crisis response team is providing free communications support to public safety agencies responding to the hurricane. As of 10/10, 47 mobile assets are in place providing extra coverage charging capacity to residents and responders.
- As of 10/7, Verizon small business and individual customers in the following areas will continue to receive unlimited calling, texting, and mobile data through 10/31: Charlotte, Collier, Desoto, Hardee, Lee, and Sarasota counties.
- As of 10/7, T-Mobile’s community support teams have set up Wi-fi and device charging stations in various locations in Fort Myers and Port Charlotte.
- As of 10/8, Comcast’s Xfinity WiFi van in Bonita Springs is providing free Wifi for all residents and businesses regardless of whether they are customers. Vans are currently stationed at Walmart locations in Fort Meyers, Port Charlotte, Naples, and at the Bonita Spring Public Library at 2687 Pine Ave. As of 10/4, Comcast suspended billing for all Sanibel, Pine Island, and Captiva residents.
- AT&T has waived talk, text, and data overage charges for Postpaid and Prepaid customers with billing addresses in the Florida zip codes (828) through 10/28.
- Florida
- Transportation
- Road Closures and Travel Updates
- Florida
- No major impacts to transportation are expected to affect supply chain and distribution of healthcare supplies. Local supply movement to areas like Sanibel Island may be impacted until roads are fully restored.
- Florida
- Road Closures and Travel Updates
Access and Re-entry
- No updates since 9/30.
- Florida
- Florida’s access and re-entry plans and policies are managed by local officials, working closely with Florida’s Division of Emergency Management. During a disaster, private sector companies should coordinate with the Division of Emergency Management, in addition to local health departments and local emergency managers to assess whether they are authorized to enter an impacted area, only after it has been deemed safe enough to do so.
- Individuals who wish to enter the disaster area must have the following on hand:
- Valid government-issued ID (driver’s license, passport)Proof of employment (employer credentials, document on company letterhead)
- Demonstrated need to enter the area (work order, inventory list, employer authorization)
- Note, DHS CISA’s Access Coordination Letter is not an acceptable document to enter any disaster areas in Florida.
Healthcare Response Updates and Needs
- Healthcare Facilities
- Healthcare infrastructure has largely stabilized as facilities are resuming normal operations. There are still ancillary facilities that remain close due to major structural damage and may impact families that depend on their services. As expected from the impacts of the hurricane, most closures are in Lee County, potentially impacting the aging, Black, and Latinx populations.
- FACHC asks Florida’s Health Centers to report their status and resources needed using the Live Response Tool or by contacting 850-591-1832 or gianna@fachc.org.
- The Agency for Health Care Administration for the State of Florida is collecting health facility status. All licensees providing residential or inpatient services are asked to update status via the Health Facility Reporting System.
- As of 10/17, HCA Florida Fawcett Hospital in Port Charlotte has resumed additional operations including surgery, radiology, select in patient service, etc.
- AdventHealth is still reporting some operational impacts from Hurricane Ian here. Most urgent care centers, primary care centers, and other specialty facilities have reopened, however patients in Central or West Florida are advised to call the location to confirm hours before traveling. Specific updates for hospitals in impacted areas are below.
- CentraCare will remain open for free video visits for non-emergency patients. Use promo code “Ian” to access free visits on the AdventHealth app.
- NCH Healthcare System status updates on services and open locations are being posted online. As of 10/13, the hospital is still only open to seeing emergency patients.
- NCH Virtual Care is accessible to anyone in the community at no cost, 24-hours per day, 7 days a week for two weeks following Ian. Use the coupon code “NCH”.
- For patients who do not have internet access, the NHC Employee Medical Center in the Greentree Plaza is open from 7:00am-7:00pm for patients to use Wi-Fi.
- Since 10/6, all Lee Health hospitals and emergency departments are fully operational. A full list of reopenings across all Lee Health facilities can be found here).
- DispatchHealth, a mobile care service, is offering home visits for Lee Health patients with injuries or illnesses that are not life-threatening. It is available in Lee County from 8:00am-8:00pm. Contact DispatchHealth by calling 239-301-3730.
- Lee Health TeleHealth remains free for the foreseeable future, and is available 24/7 through the Lee TeleHealth app. Patients without internet access can contact 855-635-1393.
- Emergency Medical Services
- No updates as of 10/11.
- As of 10/6, Disaster Medical Assistance Team’s (DMATs) are currently in place at Cape Coral Hospital and Lee Memorial Hospital.
- Florida Department of Health’s Division of Emergency Preparedness and Community Support continues to support patient movement requests and special need shelter requests.
- Pharmacy
- Rx Open is activated for Georgia, Florida, South Carolina, and North Carolina. It was last updated on 10/18 at 2:00pm EDT and is showing 9 pharmacy closures across Florida and Georgia, with closures primarily in Florida.
- Please see the table outlining pharmacy statuses per state below:
- OptumRx provided guidance to customers for rerouting existing prescription deliveries to new addresses.
- Pharmacy deliveries via Express Scripts may arrive late as recovery operations continue.
- Dialysis
- As of 10/12, all dialysis centers in Florida that were temporarily affected by Hurricane Ian impacts, have reopened.
- See Kidney Community Emergency Response (KCER’s) Hurricane Ian webpage to share information with the dialysis community.
- Network 7: HSAG Florida ESRD Network
Helpline: 800.826.3773 - Network 8: Alliant ESRD Network 8
Helpline: 877.936.9260
- Network 7: HSAG Florida ESRD Network
- Healthcare Facilities
Public Health Impacts
- Infectious illnesses
- With people entering and/or remaining in shelters due to the hurricane, there is an increased risk of transmission of COVID-19 and other infectious diseases.
- Chemicals/Flood Water
- As of 10/18 no other carbon monoxide related deaths have been reported in Florida.
- Gas and diesel can generate carbon monoxide when generators are not properly used. This can cause dizziness, headaches, and other negative health effects. Breathing can also be impacted by mold and pollutants in the air. Practice safe generator usage to decrease risk of health implications.
- Mosquito-borne illnesses
- As of 10/5 the CDC reports 414 (+69) cases of Dengue Fever, 16 of which were transmitted locally. Any remaining stagnant water from the hurricane may cause an increase in the illness.
- Stagnant water that pools and develops in the aftermath of hurricanes can promote an increase in mosquitos and other insects that carry illnesses.
- There are several key methods for protection, including: wear long sleeve shirts and pants, use EPA-registered insect repellant, and drain water from outdoor containers when possible.
- Waterborne hazards
- As of 10/14 there have been 65 confirmed cases of vibrio vulnificus in Florida, with Lee County reporting 29 infections and 4 deaths.
- As of 10/15 Florida confirms there were 17 million gallons of wastewater released into Manatee County waters 24 hours after Hurricane Ian.
- According to the Governor’s office, Florida Department of Health’s Division of Medical Quality Assurance has been informing health care providers about the increase in vibrio vulnificus infections due to exposure to flood and standing waters caused by Hurricane Ian.
- Waterborne hazards are common after a hurricane because of the high amounts of water that buildup post storm and flood. Experts recommend avoiding drinking tap water, using water filters when possible, and to refrain from walking through flood waters when possible.
- Mental health
- Mental health resources for individuals and communities are available at MyFLFamilies.com/HurricaneIan. The state has compiled a list of mental health resources at https://www.floridadisaster.org/dem/recovery/disaster-mental-health-resources/.
- The Crisis Center of Tampa Bay offers a free mental health helpline for first responders and their loved ones. The program focuses on Charlotte, Collier, DeSoto, Glades, Hendry, Hillsborough, Lee, Manatee, Pasco, Pinellas and Sarasota counties. Firefighters, police officers, emergency care providers and other first responders can reach the program by filling out a web form at lasttoask.com and can receive confidential support by calling 1-866-435-4376 (1-866-4FL-HERO).
- Florida Blue is offering free virtual doctors’ visits and a bilingual emotional support helpline for Floridians impacted by Ian at 855-225-5032 for visits, and the helpline at 833-848-1764 for emotional support. Both lines are available 24/7.
- The Florida Behavioral Health Association provides a list of helplines offered to Floridians in various counties, including an Aspire Health Partners helpline that residents of Orange, Osceola, Lake and Seminole counties can call at 407-875-3700, ext. 2.
- The Veterans Crisis Line is a free, confidential resource that is available to veterans 24/7. The service is available to all veterans, even if you are not registered with the VA or enrolled in VA healthcare. You can call 800-273-8255 ext. 1, text 838255, contact the veterans crisis chat, or dial 988 ext.1
- The Hurricane Ian disaster recovery hotline is available for mental health needs, disability services, military and veteran assistance, and other needs.
- Individuals may call or text 211 to be connected with help for physical and mental health needs and assistance in the aftermath of Hurricane Ian.
- The SAMSHA Disaster Distress Helpline 1-800-985-5990 is open 24/7 to provide immediate crisis counseling for people who are experiencing emotional distress. The Helpline is toll-free, multilingual, and confidential and is available to all residents in US and its territories via phone or text. Deaf or hard of hearing callers can utilize a videophone or ASL Now.
- Other
- Persons found and reported safe can be reported at safe.fl.gov.
- This website is for reporting missing persons related to Hurricane Ian.
- US government agencies have shared that routine non-criminal immigration enforcement operations will not be conducted at evacuation sites or assistance centers.
- Disaster Unemployment Assistance (DUA) is available to Florida businesses and residents in FEMA disaster-declared counties whose employment or self-employment was lost or interrupted as a direct result of Hurricane Ian.
Supply Chain
- Manufacturing
- No updates as of 10/18.
- Manufacturers in Florida have not reported any major impacts. There are no expected impacts to Georgia, South Carolina, and North Carolina supply chain.
- Distribution
- As of 10/18, UPS is continuing to report that most UPS facilities are operational as conditions permit. There will still be no pickups or deliveries today in zip codes listed below . Disruptions in service to Pine Island may decrease soon as a temporary bridge restoring road access to the island has been established as of 10/6.
- 33924 – Captiva
- 33957 – Sanibel
- 33931 – Fort Myers
- As of 10/18, FedEx is reporting delays and disruptions for inbound and outbound shipments in the following zip codes below. Much like UPS, the service areas affected are in barrier island counties and along the southwest coast of Florida which is where Hurricane Ian did the most damage to critical infrastructure and roadways. As temporary bridges and roadways clear, we expect the disruption to services areas to decrease.
- 33952 – Bokeelia
- 33924 – Captiva
- 33957 – Sanibel
- 33931 – Fort Myers
- 33956 – St. James
- 33993 – Cape Coral
- As of 10/18, US Postal Service reports that 11 facilities remain temporarily closed until further notice. Each of the 11 facilities have an alternate location provided.
- As of 10/18, UPS is continuing to report that most UPS facilities are operational as conditions permit. There will still be no pickups or deliveries today in zip codes listed below . Disruptions in service to Pine Island may decrease soon as a temporary bridge restoring road access to the island has been established as of 10/6.
Resource Staging
- As of 10/13, all PODs that had been distributing food, water, fuel, etc. have been stood down.
- More than 14 million meals and 51 million bottles of water have been distributed so far.
- 6 barges are aiding in the delivery of commodities in Lee County to Pine Island and Sanibel.
- Areas and counties eligible for FEMA Individual Assistance include Big Cypress Indian Reservation, Brevard, Brighton Indian Reservation, Charlotte, Collier, DeSoto, Flagler, Fort Pierce Indian Reservation, Hardee, Hendry, Highlands, Hillsborough, Hollywood Indian Reservation, Immokalee Indian Reservation, Lake, Lee, Manatee, Monroe, Okeechobee, Orange, Osceola, Palm Beach, Pinellas, Polk, Putnam, Sarasota, Seminole, St. Johns, Tampa Reservation, and Volusia. Impacted residents can apply at DisasterAssistance.gov.
- Florida’s Department of Children and Families (DCF) has created a First Responder Support Line (407-823-1657) that all first responders throughout the impacted areas can contact. This line combines current resources into a single point of contact that will connect first responders with mental health professionals.
- The USACE has activated Operation Blue Roof to provide temporary tarp-like covering to help reduce further damage to property until permanent repairs can be made. This service is free to homeowners, and the initial sign-up period is set for 21 days, ending on October 23. Five counties are currently eligible: Lee, Charlotte, Sarasota, Collier, DeSoto.
- The State of Florida and FEMA have opened two additional Disaster Recovery Centers (DRC) in Orange and Osceola counties.
- On 10/10, the Federal Emergency Management Agency (FEMA) approved Florida’s request to amend the Major Disaster Declaration issued on September 29, to assist with Hurricane Ian recovery efforts. The amendment extends the declaration to Brevard, Orange, and Osceola counties to get assistance to all counties in need. A Major Disaster Declaration provides a wide range of federal assistance programs for individuals, as well as funds for both emergency and permanent work and public infrastructure.
Emergency Prescription Refills
- Florida
- As of 9/24, early prescription refills are permitted under the State of Emergency. Opioids are considered a controlled substance, and therefore excluded from emergency prescription refill laws.
- You can obtain a 30-day refill of your prescription medication – even if you have just refilled it – if you reside in a county that:
- Is under a hurricane warning issued by the National Weather Service;
- Is under a state of emergency executive order declared by the Governor; or
- Has activated its emergency operations center/emergency management plan.
- About 13% of Florida’s population is uninsured. The Emergency Prescription Assistance Program (EPAP) is the federal program that provides medication coverage for uninsured patients, but the program has not yet been activated. The uninsured population under age 65 in areas impacted by Ian is especially high:
- Hendry County: 27.6%
- DeSoto County: 25.4%
- Lee County: 19.3%
- Collier County: 17.9%
- Charlotte County: 16.9%
- Sarasota County: 15.8%
- Centers for Medicare & Medicaid Services (CMS) implemented the 1812 Waiver and 1135 Waiver in response to the Public Health Emergency (PHE) declaration. These waivers and modifications are intended to ensure individual pharmaceutical and medical needs are met during emergency and disaster situations.
- As of 10/11, individuals that live in one of the 67 impacted counties who have Blue Cross Blue Shield of Florida (Florida Blue and Truli) memberships can access early prescription refills for maintenance medications through 11/23/2022.
- People impacted can receive a 30-day supply.
- Teledoc, the virtual healthcare system is available for $0 cost to those impacted by Hurricane Ian.
- Patients can call 855-225-5032 to reach doctors 24/7 for basic care and prescriptions and prescription refills that are not controlled substances.
- As of 9/29, Humana Healthy Horizons™ in Florida will provide special accommodations for prescription access until the PHE declaration has ended, and or, 30 days has passed since the initial event.
- As of 9/28, Cigna has lifted certain medical and benefit pharmacy restrictions.
- As of 9/28, Molina Healthcare of Florida is suspending all prior authorization requirements for prescription refills until the state of emergency is lifted.
Evacuations and Curfews
- Evacuations:
- As of 10/18, Lee and Osceola counties remain under mandatory evacuation orders.
- As of 10/18, Seminole County remains under a voluntary evacuation order.
- Curfews:
- Although Lee County lifted their countywide curfew, a curfew remains in place from 9pm-6am on Pine Island and Captiva.
- As of 10/18, Osceola County’s mandatory curfew from 9pm to 6am remains in effect.
- As of 10/12, the City of Sanibel’s mandatory curfew from 7pm-7am remains in effect.
- As of 10/4, the City of Sanibel began issuing Hurricane Reentry Passes for residents and business owners to grant reentry to the island.
- From local news sources:
- As of 10/18 access to Fort Myers Beach from the south will be limited to essential response personnel to speed restoration of essential services and infrastructure. Starting Wednesday, 10/19, residents and their hired contractors can access the island from the south from 9 am to 5 pm.
- The Bonita Beach area curfew, including the areas in Big Hickory Island and Little Hickory Island, is still in place from 7pm-7am.
- A mandatory curfew is in place for all unincorporated areas of Collier County from 12am-6am. The City of Naples curfew remains in place from 10pm-6am for residential neighborhoods until further notice.
Sheltering
- As of 10/18, Florida Disaster Maps shows there are 6 general population shelters and 1 Special Needs Shelter open in the state.
- FDEM in partnership with FEMA, activated the Transitional Sheltering Assistance (TSA) Program for residents in all counties declared for FEMA Individual Assistance. Under the program, impacted residents who applied for disaster assistance may be eligible to shelter in a hotel or motel paid by FEMA.
- The American Health Care Association (AHCA) activated the Emergency Patient Look-Up System (E-PLUS), which can be utilized by special needs shelters for 16 counties to retrieve patient medical records.
- Full list and map of shelters open in Florida can be found on the Florida SERT site.
- A list of open American Red Cross shelters can be found here.